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Neurocognitive Outcomes in Multiethnic Pediatric Brain Tumor Patients Treated With Proton Versus Photon Radiation
Soumya Unnikrishnan1,2, Anthony T Yip1,2, Alexander S Qian1,2
1University of California San Diego School of Medicine.
Insights
Pediatric brain tumor patients receiving radiation therapy showed cognitive impairment in most domains, except executive function. Radiation type did not impact outcomes, but Hispanic patients experienced worse cognitive effects, requiring further investigation.
Area of Science:
- Pediatric Oncology
- Radiation Oncology
- Neuroscience
Background:
- Pediatric brain tumors are a significant health concern.
- Radiation therapy is a common treatment modality.
- Understanding neurocognitive outcomes post-radiation is crucial for long-term patient well-being.
Purpose of the Study:
- To analyze post-radiation neurocognitive outcomes in pediatric brain tumor patients.
- To compare outcomes between photon radiotherapy (XRT) and proton radiotherapy (PRT).
- To investigate the impact of ethnicity on neurocognitive function after radiation therapy.
Main Methods:
- Retrospective analysis of 49 pediatric patients with primary brain tumors.
- Assessment of cognitive, behavioral, and overall intelligence outcomes.
- Comparison of neurocognitive impairment rates and scores between XRT and PRT groups using Fisher exact and t-tests.
- Linear regression to assess associations between radiation modality and outcomes.
Main Results:
- Cognitive impairment was observed in 16%-42% of patients across most domains, excluding executive function.
- No significant differences in neurocognitive outcomes were found between XRT and PRT groups.
- Hispanic patients demonstrated lower Verbal Comprehension Index and General Ability Index scores compared to non-Hispanic patients.
Conclusions:
- Radiation therapy for pediatric brain tumors affects most cognitive domains, with executive function being an exception.
- Radiation modality (XRT vs. PRT) is not associated with neurocognitive outcomes.
- Hispanic pediatric patients may be at higher risk for adverse post-treatment cognitive effects, necessitating further research.
Background:
We analyzed post-radiation (RT) neurocognitive outcomes in an ethnically diverse pediatric brain tumor population undergoing photon radiotherapy (XRT) and proton radiotherapy (PRT).
Procedure:
Post-RT neurocognitive outcomes from 49 pediatric patients (37% Hispanic/Latino) with primary brain tumors were analyzed. Tests included cognitive outcomes, behavioral outcomes, and overall intelligence. For each outcome, proportion of patients with cognitive impairment (scores <1.5 SD) was calculated. The Fisher exact tests compared proportion of patients with impairment and t tests compared T-scores between XRT (n=32) and PRT (n=17) groups. Linear regression assessed associations between radiation modality and outcomes.
Results:
Median follow-up was 3.2 and 1.8 years in the XRT and PRT groups, respectively. The median RT dose was 54.0 Gy. We found impairment in 16% to 42% of patients across most neurocognitive domains except executive function. There was no difference in scores between XRT and PRT groups. Regression analyses revealed no association of neurocognitive outcomes with radiation modality. Non-Hispanic patients had better Verbal Comprehension Index and General Ability Index scores than Hispanic patients ( P <0.05).
Conclusions:
Among pediatric patients with brain tumors receiving RT, all cognitive domains were affected except executive function. Radiation modality was not associated with neurocognitive outcomes. Hispanic patients may be more vulnerable to posttreatment cognitive effects that warrant further study.
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